Provider Demographics
NPI:1770608556
Name:MESSINA, KATHLEEN A (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:MESSINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 COLOMA RD STE 709
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4464
Mailing Address - Country:US
Mailing Address - Phone:916-335-9038
Mailing Address - Fax:916-638-1734
Practice Address - Street 1:11344 COLOMA RD STE 709
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4464
Practice Address - Country:US
Practice Address - Phone:916-335-9038
Practice Address - Fax:916-638-1734
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS113731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical